Susan A. Flocke, PhD

1. Mixing Research MethodsAn approach to letting the evolving research question drive a PBRN line of investigation Susan A. Flocke, PhD Associate Professor of Family Medicine, Epidemiology & Biostatistics, and Oncology Kurt C. Stange Professor of Family Medicine, Epidemiology & Biostatistics, Sociology and Oncology Case Western Reserve University October 16, 2008

2. Overview I.Introduction II. Qualitative Methods - Quantitative and qualitative inquiry differences - Traditions - Decisions that drive study approach III. Mixed Methods - Overview and history - Approaches and Designs • Example line of inquiry and spinoff studies • Cross-disciplinary process

3. Quantitative and Qualitative features

4. Qualitative Methods - Traditions

5. Decisions that drive a study Epistemology – the theory of knowledge Philosophical / theoretical perspective Study design Specific methods

6. Mixed Methods General consensus that no longer a quantitative vs. qualitative methods – both are necessary. Scope of mixing methods – within study – within line of inquiry – within broad topic area

7. Mixed Methods Attack the research problem with an arsenal of methods that have non-overlapping weaknesses in addition to complementary strengths. J Brewer & A Hunter Foundations of multimethod research: Synthesizing styles. Sage 2006. page 4.

8. Approaches to mixing methods Sequential studies Quantitative  Qualitative Qualitative  Quantitative Mixed methods in same study Dominant/ Less Dominant Secondary method plays a small role Concurrent Both Quantitative and Qualitative data collected & analyzed in a complementary manner Stange KC, Miller WL, Crabtree BF, O’Connor PJ, Zyzanski SJ. Multimethod research: Approaches for integrating qualitative and quantitative methods. J Gen Int Med, 1994; 9:278-282.

9. Approaches to mixing methods Data transformation – convert data of one type to the other can be analyzed together. Typology development – one type of data used to develop a typology that is used to drive analysis with other type of data. Extreme case analysis – pursue data collection or analysis of data of the other type with the intent of refining the initial explanation for the extreme case.

10. Example line of inquiry

11. Direct Observation of Primary Care • Cross-sectional observation of 84 family practices & 4454 patient visits to 138 physicians in Ohio • Direct Observation Davis Observation Code Checklists • Medical Record Reviews • Patient Exit questionnaire • Billing Data • Practice Environment Checklist • Ethnographic Fieldnotes

12. Prevention & Competing Demands • In-depth multimethod comparative case study of 18 family practices & 1,600 visits to 56 clinicians in Nebraska • Longer direct observation of practice environment recorded in checklists and field notes (4-8 weeks of observation) • Direct observation of 30 encounters/clinician recorded in checklists and field notes • Chart audits of patients who were observed • Interviews of all clinicians, most staff, some community members

13. Study To Enhance Prevention by Understanding Practice (STEP-UP) • Randomized clinical trial of 80 family practices in Ohio • Multimethod assessment (MAP) of values, structures, and processes • Patient survey and medical record review to assess preventive service delivery at 6 month intervals • Practice-individualized intervention

14. Spinoff studies

15. A Typology of Collaboration • Multidisciplinary • Interdisciplinary • Transdisciplinary Crabtree BF, Miller WL, Adison RB, Gilchrist VJ, Kuzel A. Exploring Collaborative Research in Primary Care. Thousand Oaks, California: Sage Publications; 1994.

16. Multidisciplinary Research • Multiple disciplines • Each contributes their piece to solving a problem • Like an edited book or separate presentations by multiple experts

17. Interdisciplinary Research • A conversation between and among disciplines • Working together on solving a common problem • Like a collaborative health care team

18. Transdisciplinary Research • A sustained conversation across and beyond disciplinary boundaries • Creates a new shared language • Such as the emergence of family systems medicine

19. 6 Stages of Collaboration • Acceptance / validation • Shared expectations • Declaring group process • Action consensus • Common space • Sustained common action

20. Benefits • Including multiple disciplines facilitates creativity and learning • Ability to better match the evolving research question and methods • Allows pursuit of multiple lines of inquiry • Process data informs results and future studies • Sharing work can increase scholarly productivity and audiences for findings • Fosters both innovation and rigor • Fun and potentially transforming

21. Pitfalls • Developing needed relationships takes time and energy • Design and analyses are continually being reinvented • Requires highly skilled and flexible data collectors and analysts

22. Transdisciplinary, Multimethod Research • Tailors the methods to the (evolving) question • Develops relationships • Well-suited for PBRN studies

23. Resources Tashakkori A. Teddlie C. Mixed Methodology. Sage Thousand Oaks CA, 1998. Brewer J., Hunter A. Foundations of Multimethod Research. Sage. Thousand Oaks CA, 2006. Creswell JW. Research Design: Qualitative, quantitative and mixed methods approaches. 2nd Ed. Sage. Thousand Oaks CA, 2003.

24. Contact Information Susan.Flocke@case.edu Kurt.Stange@case.edu